A neuroma is a painful swelling of a nerve in the ball of the foot. Symptoms include sporadic pain; burning, tingling or numbness of one or more toes. Pain is often soothed by removing the shoe or by massaging the area.
In the foot, there are the long bones (metatarsals) and thin nerves running between them. The nerves split in a Y-shape when extend into the toes. The nerve can be pinched between the metatarsals and the overlying ligament, causing it to enlarge. As it gets bigger, it is more likely to get pinched, and thus begins a cycle of pain. At some pout with chronic irritation, the nerve becomes abnormal. Morton’s Neuroma is the most common of this type and often affects the nerve between the third and fourth toes. Neuromas may also occur after a nerve has been injured, either from a traumatic wound or from damage suffered during surgery.
A physical examination and one or more imaging tests will determine whether the pain is caused by a neuroma or by a condition with similar symptoms such as arthritis, stress fractures, or capsulitis of the adjacent joint. Treatment begins with a combination of metatarsal pads or cortisone injection. If the nerve is permanently damaged, the patient may decide to have the nerve surgically removed.
Hallux rigidus, meaning “stiff big toe,” is a type of degenerative arthritis affecting the joint located at the bottom of the big toe (the metatarsophalangeal joint). This condition causes the joint to stiffen and become painful, eventually making it difficult to walk, stand up, bend, squat or run. Hallux rigidus may occur as a result of structural abnormalities, heredity, traumatic injury, or underlying disease conditions, such as rheumatoid arthritis or gout.
As the arthritis progresses, bone spurs form along the top of the big toe joint. These spurs then limit bending of the toe while walking. Without about 30-40 degrees of motion, one then rolls to the side of the foot while walking. Pain Hallux rigidus is diagnosed through the taking of a medical history, physical examination and X-rays.
There are several treatment options for hallux rigidus, depending on the severity of the condition and the patient’s mobility issues. Nonsurgical treatments include:
- Avoiding activities that cause pain, such as running
- Wearing shoes with a rocker sole
- Wearing orthotics with firm extension under the big toe joint
- There are a few surgical procedures that may be performed to relieve hallux rigidus, depending on individual circumstances. These include:
- Cheilectomy: removing the bone spurs
- Cheilectomy and phalangeal osteotomy(Moberg): removing the bone spurs, as well as a bone cut of the toe bone to increase motion
- Capsular Arthroplasty: implanting one’s own tissue in the joint
- Arthrodesis: joint fusion
The goal with surgery is to preserve the joint as much as possible, decrease pain, and increase motion. Most often, the recommendation is cheilectomy.